title: Cost effectiveness of proton therapy compared with photon therapy in the management of pediatric medulloblastoma.
abstract: BACKGROUND
  Proton therapy has been a hotly contested issue in both scientific publications and lay media. Proponents cite the modality's ability to spare healthy tissue, but critics claim the benefit gained from its use does not validate its cost compared with photon therapy. The objective of this study was to evaluate the cost effectiveness of proton therapy versus photon therapy in the management of pediatric medulloblastoma.
  
  
  METHODS
  A cost-effective analysis was performed from the societal perspective using a Monte Carlo simulation model. A population of pediatric medulloblastoma survivors aged 18 years was studied who had received treatment at age 5 years and who were at risk of developing 10 adverse events, such as growth hormone deficiency, coronary artery disease, ototoxicity, secondary malignant neoplasm, and death. Costing data included the cost of investment and the costs of diagnosis and management of adverse health states from institutional and Medicare data. Longitudinal outcomes data and recent modeling studies informed risk parameters for the model. Incremental cost-effectiveness ratios were used to measure outcomes.
  
  
  RESULTS
  Results from the base case demonstrated that proton therapy was associated with higher quality-adjusted life years and lower costs; therefore, it dominated photon therapy. In 1-way sensitivity analyses, proton therapy remained the more attractive strategy, either dominating photon therapy or having a very low cost per quality-adjust life year gained. Probabilistic sensitivity analysis illustrated the domination of proton therapy over photon therapy in 96.4% of simulations.
  
  
  CONCLUSIONS
  By using current risk estimates and data on required capital investments, the current study indicated that proton therapy is a cost-effective strategy for the management of pediatric patients with medulloblastoma compared with standard of care photon therapy.
authors.affiliation: Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Raymond B
authors.initials: RB
authors.lastname: Mailhot Vega
authors.forename: Jane
authors.initials: J
authors.lastname: Kim
authors.forename: Marc
authors.initials: M
authors.lastname: Bussière
authors.forename: Jona
authors.initials: J
authors.lastname: Hattangadi
authors.forename: Abby
authors.initials: A
authors.lastname: Hollander
authors.forename: Jeff
authors.initials: J
authors.lastname: Michalski
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: Torunn
authors.initials: T
authors.lastname: Yock
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D002528:Cerebellar Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D002675:Child, Preschool; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006801:Humans; D008137:Longitudinal Studies; D008527:Medulloblastoma / Q000191:economics* / Q000532:radiotherapy*; D018803:Models, Economic; D009010:Monte Carlo Method; D017785:Photons / Q000627:therapeutic use*; D061766:Proton Therapy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years
keywords: Monte Carlo; comparative effectiveness; cost effectiveness; medulloblastoma; proton